Impact of HeartMate 3 left ventricular assist device infection on outcomes following heart transplant.

BACKGROUND

Infectious complications are common in patients implanted with HeartMate 3 (HM3) left ventricular assist devices (LVAD). Despite these issues, some patients with LVAD-specific infection are ultimately considered for heart transplant (HT). The impact of HM3 LVAD-associated infection on postHT outcomes remains unclear.

METHODS

We reviewed all adult patients who were listed for HT at Duke University Hospital between 1/1/2014 and 12/31/2024 (n = 1267) and identified 115 patients with a HM3 device who underwent HT. These 115 patients were further stratified based on pre-HT LVAD-specific infection. We assessed the impact of LVAD-specific infection on short-term postHT complications, including length of hospitalization, primary graft dysfunction (PGD), episodes of acute rejection, and occurrences of postHT hospitalization with infection up to 1-year. Kaplan-Meier analysis was used to assess risk of death after HT.

RESULTS

Of the 115 patients, 59 patients (51%) had HM3 LVAD-specific infection prior to HT. Compared to patients without pre-HT LVAD-specific infection, there was no difference in 1 year post-HT survival (p = 0.14). Similarly, there was no difference in postHT length of stay (p = 0.435), treated acute rejection (p = 0.536), or severe PGD (p = 0.166).

CONCLUSIONS

For carefully selected patients with HM3 LVAD-specific infections, HT appears to be a safe option without excess short-term morbidity or mortality HT.